臨牀消化器内科 Vol.20 No.6(6-2)


特集名 小児の腹痛とその処置 -- 最新の捉え方
題名 腹痛をきたす小児の重要疾患 -- その診断と治療 (2) 急性虫垂炎
発刊年月 2005年 06月
著者 金森 豊 東京大学医学部小児外科
【 要旨 】 小児急性虫垂炎はどの年齢でも発症しうる疾患であるが,年長学童期にとくに多くみられる.診断には右下腹部の限局性の圧痛を正しく判断することが大切で,年少児の場合には慎重に腹部所見をとる姿勢が重要になる.また最近では腹部超音波検査で腫大した虫垂を描出することが客観的虫垂炎の診断として重要視されており,有用である.カタル性虫垂炎は保存的治療,腹膜刺激症状が出現した蜂窩繊炎性,壊死性虫垂炎は手術治療が原則である.腹腔鏡手術も最近では多くの施設が取り入れている.術後には,創感染,イレウス,遺残腫瘍などの合併症に注意が必要である.
Theme Abdominal Pain in Children : Current Clinical Management
Title Acute Appendicitis in Children : Diagnosis and Treatment
Author Yutaka Kanamori Department of Pediatric Surgery, The University of Tokyo Hospital
[ Summary ] Acute appendicitis is a very common surgicaly treated disease seen in all ages under fifteen. However, children around ten years old are most commonly affected by this condition. In order to achieve correct diagnosis of the disease, we should judge through careful palpation of the abdomen of the patient who has localized right-lower abdominal pain. Especially in those under five years of age it is very difficult to obtain correct abdominal findings. Recently, abdominal ultrasonography has become a very useful examination tool to obtain images of an inflammed appendix. We select surgical treatment for phregmonous and gangrenous appendicitis whereas, in catarrhal appendicitis conservative therapy should be chosen. Laparoscopic appedectomy has become the standard procedure in many institutes. After surgery patients should be carefully followed because postoperative wound infections, intestinal obstructions, and abscesses in the peritoneal cavity are often complications of severe appendicitis.
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